Concordia College-Selma
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Track Prospect Form:

1.
*

I am applying for:

 (1 required)
Fall Semester 2009   Spring Semester 2010

PROSPECTIVE STUDENT-ATHLETE INFORMATION:
2.
* Last Name, First Name, M.I. (Maiden)
3.
* Home Street Address:
4.
* City, State, County, Zipcode:
5.
*

Telephone Number (Indicate Home or Cell & include area code)
6.
*

Sex:
Female   Male
7.
* Date of Birth (month/day/year):
8.
Place of Birth:
9.
* Name of Graduating High School / Year:
10.
High School Street Address / City / State / Zipcode:
11.

Current Grade Point Average:
12.

Name/Number  of current Track Coach
13.
*

What Event(s) do you regularly compete in?

 (1 required)
100m Dash   Shotput
200m Dash   Discus
400m Dash   Hammer Throw
800 m   Javelin
1500 or 1600 m   Long Jump
3200 m   Triple Jump
5000 m   High Jump
5000m Steeple Chase   300m Hurdles
4x100m Relay   4x800 Relay
4x400 Relay   110m High Hurdles
14.

Use this box to input any events that are not listed above.
15.
*

How did you learn about Concordia College-Selma?

 (1 required)
High School / College Fair   High School Counselor
High School Presentation   Poster/Radio/TV/Newspaper
College Presentation   Internet
College Guide   Currently Enrolled Student
Other   Concordia College Athletic Website
16.

Name of Recruiter or Person who Recruited You:
Parent/Guardian Information
17.
* Name of Parent or Guardian(s):
18.

Street Address of Parent or Guardian(s):
19.
Parent/Guardian(s) City / State / Zipcode:

* Enter Your Email Address:

Type in the text that you see above:

  

 

 

Concordia College Selma       
1804 Green Street
Selma, AL 36701
Phone: 334-874-5700
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